Visiting Lecture: Fifty Years After “The Battered Child:” What’s Left to Do?

Posted on May 9, 2013

On April 25, the Schubert Center, in collaboration with the UH Rainbow Babies and Children’s Hospital Pediatric Grand Rounds, hosted Richard Krugman, MD, Vice Chancellor for the Office of Health Affairs, University of Colorado for a talk titled Fifty Years After “The Battered Child:” What’s Left To Do?, referencing a landmark article published in 1962 by Henry Kempe, MD and colleagues on recognizing the symptoms of child abuse. The talk presented a history and description of child maltreatment as well as areas for future improvement.

Krugman presented an early history of the recognition of child abuse by physicians, beginning in 1860, followed by a description of common forms of maltreatment, including physical abuse, sexual abuse and neglect. He noted that responses to child maltreatment differ by type of abuse and whether abuse occurred inside or outside of the child’s family, with physical abuse and neglect within the family handled through the family court system and sexual abuse being criminally prosecuted. He also described the different epidemiology of sexual abuse by gender, noting that most abuse among boys occurs outside the family and most abuse among girls occurs within the family. Unfortunately, the true number of child maltreatment incidents is unclear due to to underreporting, though it is clear that neglect is a more prevalent problem than physical abuse or sexual abuse. The data that are available show a clear decline in the rates of both physical and sexual abuse over the past 20 years, though the rates of neglect remain largely unchanged.

According to Krugman, during the first 15 years after the publication of Kempe’s article, the child welfare system largely targeted physical abuse and had good outcomes. However, the next 15 years were characterized by a poor response to child maltreatment following the recognition of child sexual abuse as a significant issue and debates regarding the appropriate response to child sexual abuse. The most recent 20 years have brought some successes, though the reasons for decreases in the rates of physical and sexual abuse are unclear.

Krugman argued for the importance of significant changes to responses to child maltreatment in order to improve outcomes for children. These changes include creating policies that are focused on treatment of abuse survivors rather than investigation, more research on incidence and evidence-based treatments, and further inclusion of communities in child abuse prevention and treatment. He also discussed the importance of identifying boys who have been sexually abused in order to reduce the negative health consequences of childhood sexual abuse and emotional difficulties that may last through adult life. Krugman argued that greatly increased funding, perhaps raised using the privately funded model of March of Dimes, is needed to effectively address the immediate and lifelong impacts of child maltreatment.